Individual provider Active NPI

David Sung-Wook Moon, M.D.

  • Neurology with Special Qualifications in Child Neurology Physician
  • Grand Rapids, MI
National Provider Identifier
1164866414
Registry record updated Jul 17, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology with Special Qualifications in Child Neurology PhysicianTaxonomy code 2084N0402X
License
4301114519 Issued in MI
Practice address
25 Michigan St NE Ste 2100
Grand Rapids, MI 49503-2526
Phone
(616) 267-2500
NPI assigned
Apr 17, 2013
Last updated
Jul 17, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology with Special Qualifications in Child Neurology Physician 2084N0402X 4301114519 MI Primary

Addresses

Primary practice location

25 Michigan St NE Ste 2100
Grand Rapids, MI 49503-2526

Mailing address

100 Michigan St NE # Mc845
Grand Rapids, MI 49503-2560

Other practice location 1

1105 Sixth St
EKG Read
Traverse City, MI 49684
Phone (231) 935-6239

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address dmoon241705@epic00.shdirect.org
FHIR URL https://epicarr02.spectrumhealth.org/EpicFHIR/api/FHIR/DSTU2/

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20181214000167 MI Practitioner - Neurology 2769727064 Reassigns benefits to 4 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
4301114519MIMDNeurology with Special Qualifications in Child Neurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Munson Medical Center Current Accepting new patients
Munson Medical Center Neurology CurrentSince Sep 28, 2019 Accepting new patients
Spectrum Health Primary Care Partners CurrentSince Jan 31, 2019 Accepting new patients
Bronson Methodist Hospital Neurology CurrentSince Oct 11, 2020 Accepting new patients
Lakeland Medical Practices CurrentSince Jul 1, 2020 Accepting new patients
Lakeland Medical Practices CurrentSince Jul 1, 2020 Accepting new patients
Spectrum Health Primary Care Partners CurrentSince Jan 31, 2019 Accepting new patients
Munson Medical Center CurrentSince Sep 28, 2019 Accepting new patients

Locations

2513 Momentum Pl
Chicago, IL 60689
Phone (231) 935-8031

100 Michigan St NE
#845
Grand Rapids, MI 49503
Phone (616) 391-8242

25 Michigan St NE
Ste 2100
Grand Rapids, MI 49503
Phone (616) 267-2500

330 Barclay Ave NE
Ste 203
Grand Rapids, MI 49503
Phone (616) 391-2123

35 Michigan St NE
Ste 3003
Grand Rapids, MI 49503
Phone (616) 267-2200

601 John St
Ste M-124
Kalamazoo, MI 49007
Phone (269) 341-7500

4444 Kalamazoo Ave SE
Ste 200
Kentwood, MI 49508
Phone (616) 391-5600

31 N Saint Joseph Ave
Niles, MI 49120
Phone (269) 428-2417

1234 Napier Ave
Saint Joseph, MI 49085
Phone (269) 982-4941

3950 Hollywood Rd
Ste 280
Saint Joseph, MI 49085
Phone (269) 408-0990

1105 Sixth St
Traverse City, MI 49684
Phone (231) 922-9000

550 Munson Ave
Ste 202
Traverse City, MI 49686
Phone (231) 935-7548

Interoperability endpoints

  • Direct secure messaging: dmoon241705@epic00.corewelldirect.org
  • Direct secure messaging: dmoon241705@epic00.shdirect.org

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1366156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1784246400000",
    "number": "1164866414",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MICHIGAN ST NE # MC845",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 MICHIGAN ST NE STE 2100",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032526",
            "telephone_number": "616-267-2500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1105 Sixth St",
            "address_2": "EKG Read",
            "address_purpose": "LOCATION",
            "city": "Traverse City",
            "state": "MI",
            "postal_code": "49684",
            "country_code": "US",
            "telephone_number": "231-935-6239",
            "fax_number": "231-935-7251",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOON",
        "first_name": "DAVID",
        "middle_name": "SUNG-WOOK",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-04-17",
        "last_updated": "2026-07-17",
        "certification_date": "2026-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0402X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology",
            "state": "MI",
            "license": "4301114519",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dmoon241705@epic00.shdirect.org",
            "affiliation": "N",
            "address_1": "35 Michigan St NE Ste 3003",
            "city": "Grand Rapids",
            "state": "MI",
            "country_code": "US",
            "postal_code": "495032528",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicarr02.spectrumhealth.org/EpicFHIR/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "35 Michigan St NE Ste 3003",
            "city": "Grand Rapids",
            "state": "MI",
            "country_code": "US",
            "postal_code": "495032528",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.